Mason Selected to Evaluate CareFirst Medical Home Program

George Mason University is part of an elite group to evaluate CareFirst BlueCross BlueShield’s Patient-Centered Medical Home (PCMH) program, one of the largest in the nation, CareFirst announced on March 11.

How well a patient’s health improves while under a physician’s care, not how many services are given, is a benchmark for patient-centered programs, Nichols says. “The patient’s health is at the center of the focus as opposed to just services and tests for the patient,” he says.

Patient-centered care also means the patients themselves play an active part in their own health care, Nichols says. That’s critical because many patients with chronic conditions typically have two or more. For example, someone with heart disease may also be diabetic.

“You have to manage care for chronic patients very carefully,” Nichols says.

In addition, the patient-centered programs are a response to cost pressures and an effort to re-examine how care is delivered to patients, Nichols says. “I think it is a game-changer for our national conversation about how to contain costs,” he says.

CareFirst has more than 3,600 participating primary care physicians and nurse practitioners covering about one million CareFirst members in Maryland, Northern Virginia and the District of Columbia. CareFirst showed total health care costs for PCMH members in 2011 were 1.5 percent lower than expected. Nearly 60 percent of physician groups participating in 2011 earned incentives based on the attainment of savings and quality performance, according to CareFirst information.

Mason’s evaluation is expected to show how well that promise is fulfilled.

“Our PCMH program is a critical component of our efforts to reduce health care costs while improving health care quality,” said CareFirst President and CEO Chet Burrell in a statement announcing Mason’s selection as a PCMH evaluator. “The program has grown tremendously, and we are pleased with the early results that we have seen. In selecting these leading institutions and organizations to evaluate the program, we will get a thorough, independent look at every aspect of the program. We want to know what works well, what could work better, whether the program is truly changing the behavior of physicians and patients and much more.”

Mason’s team includes three health economists, a professor of nursing, a physician and a consumer engagement expert who can detail what can help bring patients into the program.

A multidisciplinary team is essential to give the program a thorough examination, Nichols says. “You need multiple perspectives,” he says. “You need all hands on deck.”